Department of Cardiothoracic Surgery, The 82nd Group Military Hospital of PLA, Baoding, Hebei, China.
Department of Rheumatology and Immunology, Baoding Children's Hospital, Baoding, Hebei, China.
Technol Health Care. 2024;32(2):511-523. doi: 10.3233/THC-230201.
Radical resection of lung cancer and chemotherapy are the main methods for the treatment of early lung cancer, but surgical treatment is still the key and preferred method.
To evaluate the efficacy and safety of robotic-assisted thoracic surgery (RATS) and video assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC).
The clinical cohort studies on the comparison of the effects of RATS and VATS in the treatment of NSCLC published in Web of Science, PubMed, The National Library of Medicine (NLM), China National Knowledge Infrastructure (CNKI) and Wanfang database from January 1, 2015 to December 31, 2022 were searched. Two researchers independently screened the literature, extracted the data, such as operation time, intraoperative conversion rate, intraoperative blood loss, number of lymph nodes dissected, and evaluated the quality of the included literature based on the Newcastle-Ottawa Scale (NOS). RevMan 5.3 software was used for Meat analysis.
A total of 18 articles and 21,802 subjects were included. The results of the meta-analysis showed that the intraoperative blood loss of RATS was significantly less than that of VAS, and the difference was statistically significant [MD =-38.43 (95% CI: -57.71, -19.15, P< 0.001)]. Compared with VATS, the number of lymph nodes dissected in RATS was significantly higher [MD = 2.61 (95% CI: 0.47, 4.76, P= 0.02)]. The rate of conversion to thoracotomy in RATS was lower, and the difference was statistically significant [OR = 0.59 (95% CI: 0.50, 0.70, P< 0.001)]. There was no significant difference between RATS and VATS in operation time [MD =-9.34 (95% CI: -28.72, 10.04, P= 0.34)], postoperative thoracic drainage time [MD =-0.08 (95% CI: -0.42, 0.26, P= 0.64)], postoperative hospital stay [MD =-0.05 (95% CI: -0.19, 0.08, P= 0.42)], postoperative mortality [OR = 0.88 (95% CI: 0.56, 1.36, P= 0.56)] and postoperative complications [OR = 1.03 (95% CI: 0.93, 1.13, P= 0.57)].
Compared with VATS, the number of lymph nodes dissected in RATS was significantly more, and the removal of lesions and lymph nodes was more thorough and accurate. More flexible and precise operation avoids the injury of important blood vessels during operation, effectively reduces the amount of blood loss during operation, shortens the indwelling time of thoracic drainage tube, and is conducive to postoperative rehabilitation of patients.
肺癌的根治性切除术和化疗是治疗早期肺癌的主要方法，但手术治疗仍然是关键和首选方法。
评估机器人辅助胸腔镜手术（RATS）和电视辅助胸腔镜手术（VATS）治疗非小细胞肺癌（NSCLC）的疗效和安全性。
检索 2015 年 1 月 1 日至 2022 年 12 月 31 日在 Web of Science、PubMed、美国国立医学图书馆（NLM）、中国知网（CNKI）和万方数据库中发表的比较 RATS 和 VATS 治疗 NSCLC 效果的临床队列研究。两名研究人员独立筛选文献、提取数据，如手术时间、术中转化率、术中出血量、淋巴结清扫数量，并根据纽卡斯尔-渥太华量表（NOS）评估纳入文献的质量。使用 RevMan 5.3 软件进行 Meat 分析。
共纳入 18 篇文章和 21802 例患者。荟萃分析结果显示，RATS 术中出血量明显少于 VAS，差异有统计学意义[MD=-38.43（95%CI：-57.71，-19.15，P<0.001)]。与 VATS 相比，RATS 淋巴结清扫数量明显增加[MD=2.61（95%CI：0.47，4.76，P=0.02)]。RATS 中转开胸的比例较低，差异有统计学意义[OR=0.59（95%CI：0.50，0.70，P<0.001)]。RATS 与 VATS 相比，手术时间[MD=-9.34（95%CI：-28.72，10.04，P=0.34)]、术后胸腔引流时间[MD=-0.08（95%CI：-0.42，0.26，P=0.64)]、术后住院时间[MD=-0.05（95%CI：-0.19，0.08，P=0.42)]、术后死亡率[OR=0.88（95%CI：0.56，1.36，P=0.56)]和术后并发症[OR=1.03（95%CI：0.93，1.13，P=0.57)]差异均无统计学意义。
与 VATS 相比，RATS 淋巴结清扫数量明显更多，病变和淋巴结的清除更彻底、准确。更灵活、精确的操作避免了术中重要血管的损伤，有效减少了术中出血量，缩短了胸腔引流管的留置时间，有利于患者术后康复。
